VHCC

VHCC - The second regional telemedicine center was created

On the background of joint decision of Georgian Telemedicine Union (Association) and Adjara Healthcare Ministry in Batumi was established telemedicine regional center. Its presentation took place at 20 October, 2006. In the frames of this event first time was done the videoconference with Tbilisi.

VHCC-Telemedicine Days in West Georgia

At 17-18 June, 2006 the seminar “Telemedicine Days in West Georgia” (Kutaisi, Georgia) was held. This was joint initiative of Georgian Telemedicine Union (Association) and Public Health Imereti Regional Center, which aimed presentation of telemedicine, its possibilities and past, current and future activities of Georgia in this direction. The special attention was given to application of telemedicine for biodefence and infectious diseases’ control issues. Videoconference sessions with Dr. Francisco G. La Rosa (Department of Pathology, University of Colorado at Denver and TelePathology Consultants, PC, USA) and Professor Michael Nerlich (Regensburg University and International Society for Telemedicine and eHealth , Germany) were performed. The presentations regarding application of computer technologies for medical aims (Alexander Mgaloblishvili, Future Technologies, Tbilisi, Georgia) and practical application of telemedicine (Ekaterine Kldiashvili, Georgian Telemedicine Union, Tbilisi, Georgia) were made. For the aim of the maximal effective, interesting and comprehensive presentation of telemedicine’s possibilities two continuous medical education programs focused upon telemedicine and its advantages were performed:

1. “eHealth – perspectives and possibilities” (10 CPE scores, №2005120). Program aims the introduction of the new field of medicine, its possibilities and perspectives to audience and the description of the possibilities to increase the quality, efficacy and adequacy of medical service through implementation of eHealth and telemedicine. The program is addressed to the following medical specialities: Pathologists, Clinical Cytologists, Oncologists, Infectionists, Cardiologists, Hematologists, Dermatologists.

2. “The application of modern technologies for diseases control” (10 CPE scores, №2006035). Program aims the description of the possibilities of application of modern technologies (computer and communication technologies) for disease control purposes. The guideline of usage of telemedicine for chronic and acute diseases’ control is given in the program. It is addressed to the following specialities: Pathologists, Clinical Cytologists, Oncologists, Radiologists, Cardiologists, Hematologists, Dermatologists, Neurologists, Pediatricians, Obstetric-Gynecologists, Internal Diseases Specialists, Public Health and Healthcare Management.

The detailed report about this event can be reached at http://georgia.telepathology.org/telemedicine-days.htm

Regional Telemedicine Unit

At 9 February, 2006 the regional telemedicine unit in Kutaisi (West Georgia) started its activity. It was created in Kutaisi Regional Public Health Center of Department of Public Health of Ministry of Labor, Health and Social Issues of Georgia. The unit is fully equipped. Its applications mainly concern: remote second opinion consultations and teleconferencing (one to one and/or multipoint).

The actuality of eHealth introduction in Georgian healthcare

The actuality of eHealth for Georgia (as the realization of distance medical service) is stipulated by the following basic moments:
- Population localization in the capital
- Centralization of healthcare
- Country geo-climatic features
- High level of treatment cost expenses.
The introduction of eHealth will ensure:
- Realization of qualified and specialized medical service in regions and rural areas;
- Shortening of time between beginning of disease and starting of treatment;
- Improvement of population health indices through reliable diagnostic and correct treatment strategy;
- Application of regional specialists’ potential;
- Realization of economic efficiency.

eHealth

The fast development of info-communication technologies and the tendencies of their successful and effective application in different fields during last decades were observed. This was reflected in Millennium Goals, particularly in 18th Goal: “The common accessibility of the modern technologies, particularly of info-communication possibilities should be realized in collaboration with private sector”. The World Health Organization (WHO) is implementing the intensive introduction of information technologies application for medical-sanitation services and healthcare aims during last ten years. In particular, at December, 1997 the International Consulting Conference organized by WHO prepared the material about “telematics” (EB101/INF.DOC./9). WHA51.9 Resolution (1998) had been determined the realization of goods of medical purpose through Internet.

The term “eHealth” is widely distributed and commonly accepted at present. It implies the application of info-communication technologies for medical aims as locally so at distance. eHealth is the unique possibility of development of public health. This topic was among questions those were revealed at the World Summit of Information Society in Geneva, Switzerland at December 2003. The Secretariat of WHO worked out the strategy project of eHealth, which determines the main directions of work in this field and actions of WHO in eHealth field by itself too.

The extremely fast development of eHealth in last period was stipulated by the progress of info-communication technologies. The electron system of health can be presented by the digital products, systems and services of medical-sanitation purpose. The mentioned technologies are extremely perspective as for low- so for high-income countries. It should be noted, that info-communication technologies have already brought benefits for the range of countries, which is reflecting not only upon the systems of medical-sanitation services, but on public health, healthcare management, finances, education, scientific research and economic activity too. At 7 April 2005 at 59th World Health Assembly (A58/21) the renewed strategy of eHealth (Provisional agenda item 13.17) was approved. In accordance with it the concept and strategy of national eHealth should be worked out by member countries. It should be emphasized, that eHealth system must ensure the increasing of medical services efficacy and the accessibility of medical-sanitation services in country at general and especially in remote areas. This should be useful and suitable possibility for providers of medical-sanitation services, specialists and users through increasing of service quality and improvement of health situation. eHealth should be positively reflected upon cost of medical service through the reducing of quantity of additional investigations and their repetitions and through ensuring of economy stipulated by scale effect.

There are organizations working in healthcare field, which not only apply the advantages of info-communication technologies in member countries, but stimulate development of eHealth significantly. No obstacle barrier interrupting exchange of medical-sanitation data exists; this is the helpful possibility for realization of operational and multilateral epidemiologic control. Working out of the global approach for data processing will ensure standardization and reducing of service cost.

The increasing of technical professionalism level in countries with low-income is observed, which is the suitable possibility to gain personal expert knowledge. Although for the most part of countries the expected benefits of eHealth were not materialized till present. As a result the speed and scale of info-communication technologies’ influence upon different healthcare systems were not determined till today. For the aim to work out individual, cost-effective models and especially to determine factors ensuring realization and stability of eHealth systems implementation of the consequent analytical studies and obtaining-exchange of the knowledge should be implemented. The necessary conditions of eHealth successful integration in medical-sanitation systems foresee the long-term commitments taken by government on the background of consequential strategic plan, realization of eHealth advantages at national level and availability of the qualified human resources.

The imbalance between accessibility of info-communication technologies and their application existed among different countries and in the borders of singular country too is observed. From this point of view the questions associated with human rights, ethical and juridical rights and especially – the accessibility of the best possible healthcare should be regulated.

VHCC - The concept of CME

At April 2005 the Telemedicine Unit was created by the Georgian Telemedicine Union (Association) at the JSC "REA" Rehabilitation Center. It aims organization of remote medical consultations, distance educational courses and the Continuous Medical Educational programmes focusing upon Telemedicine, eHealth and their applications.

At November 2005 the Georgian Telemedicine Union (Association) in collaboration with the Telemedicine Unit of JSC "REA" Rehabilitation Center worked out the CME programme "eHealth - Perspectives and Possibilities", which aims the introduction of the new field of medicine, its possibilities and perspectives to audience and the description of the possibilities to increase the quality, efficacy and adequacy of medical service through implementation of eHealth and telemedicine.

This programme is addressed to the following medical specialities:
- Pathologists
- Clinical cytologists
- Oncologists
- Radiologists
- Infectionists
- Cardiologists
- Hematologists
- Dermatologists
Each course can be attended by the 30 listener.

The duration of programme "eHealth - Perspectives and Possibilities" is estimated as 2 working days (11 educational hours), it will be realized through lectures (45 min of duration each) and seminars (2x45 min of duration each).

Creation of the other CME programmes focused eHealth and telemedicine and their applications will be worked at next steps.

VHCC - The description of case consultations

At July 2005, the usage of VHCC server for consultation purposes started, which is organized by the usage of the tool Simple Machine Forum. For the purpose to organize remote consultation in the most effective and comprehensive degree each case contained as description (the resume of medical history) and illustrations (microphotographs, CT images, X-rays and etc.). Just to create the full impression regarding the case the resume of medical history includes the data regarding the patient's objective condition, complaints, working diagnosis and clinical findings.

All illustrations were captured by the digital camera at resolution 5.0 mln pixels, transferred at PC and edited by the PhotoShop, particularly the images were optimized in contrast, brightness and sharpness by Adobe PhotoShop 5.0, then compressed and saved in JPEG format files at a resolution of 500x375 pixels.

As soon as the case was uploaded at the server the notification letter was sent to experts.

Since July 2005 till 28 November, 2005 79 cases were discussed at server.

Base Server of VHCC is ready

The first step (see Feb. 14th – General Time Frame) has completed.
You can reach the service at http://vhcc.charite.de/
All services are basically preconfigured.

Online Help is available via the start-up page.

A regular backup routine is arranged.

There are 3 main interindependently services available on the server:

• eGroupWare (GroupWare)
  
  
  
  • Calendar
  
  
  • Address book
  
  
  • News
  
  
  • Forum
  
  
  • Project Documentation
  
  
  • Trouble Ticket System
  
  
  • Knowledge Base
  
  
  • Bookmarks
  
  
  • Polls
  
  


• Moodle (Online Course Management System/LMS)
  
  • Teacher/ Student Login
  
  
  • Calendar
  
  
  • Online Courses
  
  
  • Online Testing (several possibilities i.e. multiple choice, direct answer, mathematics, …)
  
  
  • File sharing
  
  
  • News
  
  


• Simple Machines Forum (Tele Consulting)
  
  
  
  • Different Categories
  
  
  • File sharing
  
  
  • Chronological Order
  
  
  • Private Messaging
  
  
  
  
• [Mambo (Content Management System)]- Not in use at present

Please note that each user has to get registered before he can use one of the services. To get an account for “eGroupWare” and “Moodle” please send an E-Mail - to

1. Marc-Oliver Berndt (vhccserver@moberndt.de), system administrator
or

2. Dr. Thomas Schrader (thomas.schrader@charite.de), NATO country project director

- that contains:

• Full name


• E-Mail address


• a short statement of grounds


• a desired user name with a desired password





For the “TeleConsulting” you can direct register at the forum itself.
Greetings

Marc-Oliver Berndt
vhccserver@moberndt.de

VHCC - Base Server

The Base-Server is running.

The server is reachable at http://vhcc.charite.de

The actual groupware tool is eGroupWare, you will find a detailed documentation there - (http://www.egroupware.org).

In aspect of security no more details of the server configuration will be published.

Now it is important to get your wishes and requirements.
Please send an Email to vhccserver@moberndt.de

Greetings,

Marc-Oliver Berndt

Telemedicine in Georgia

In Georgia there were implemented two ITU supported telemedicine projects. The first one was started in September 1998 and involved the connection of the Institute of Radiology in Tbilisi to the Diagnostic Imaging Centre in Lausanne, Switzerland via the Internet in order to acquire medical second opinions. In the frames of this project Vidar VXR-12-Plus was used for CT and MRI images digitization.

The second telemedicine project – Telecardiology, it was implemented the simple method of ECG transfer using ordinary telephone receiver. It was partly funded with excess revenues generated by the International Telecommunication Union (ITU) Telecom exhibitions. Project enabled a trans-telephonic electrocardiogram for diagnostic and emergency services. The project was one of several others which were implemented in selected developing countries as part of the ITU's strategy to use information technology to help health professionals solve some of the most acute health care issues in developing as well as emerging economies, according to Recommendation Nine of the Valetta Action Plan adopted by the ITU in 1998. Partners in the project include the Tbilisi Cardiac Clinic GULI, Telecommunication Company of Georgia and the Telemedicine Foundation of Russia.

But in Georgia there were implemented other telemedicine projects too. In 1996 and 1997 National Association of Cancer Control established e-mail communication and conducted teleradiological and telemorphological conferences through financial support of Open Society Georgia Foundation. Particularly, X-ray grams, histograms and cancer incidence data base were transferred from Batumi (Adjara region) to Tbilisi National Cancer Center by e-mail.

Heart and Vascular Clinic uses Agfa Deluxe Slide Scanner for teleradiology. The center also transfers phonocardiograms, ECG and Video .avi files to medical centers in Germany and US for second opinion gathering.

Emergency Cardiology Center and National Information Learning Center are implementing telecoronography (telecardiology/teleradiology) – transfer of x-ray images for second opinion to German and Turkish colleagues (by usage the both HP Scanjet and Apple 1 scanner as well as Olympus Camedia D-620L high resolution digital camera).

Center of Disaster and Emergency Medicine has developed software and tested TelCoNet – Teleconsultation network project for emergency medicine.

In 2004 in Georgia was established non governmental organization Georgian Telemedicine Union (Association), which organizes remote consultations and educational sessions in different medical fields. Remote consultations are implementing as in static (through consultational servers and e-mail) so in dynamic (teleconferencing) modes by using NetMeeting. The same approach is used in carrying out of educational sessions. At 2005 Georgian Telemedicine Union (Association) starts implementation of NATO Networking Infrastructure Project “Virtual Health Care Knowledge Center in Georgia”, which aims creation of telemedicine consultation server, organization of e-Learning courses and also set-up of telemedicine unit in Kutaisi. Georgian Telemedicine Union (Association) is also implementing BSEC project “A system to fight HIV/AIDS, tuberculosis and malaria in BSEC countries with a help of infocommunication technologies” in collaboration with Russia and Ukraine.

Magistral Fiber Optic Cable System in Georgia 

Telecommunication in Georgia

No state- or private company-owned satellite, major contracted satellites – INTELSAT, TURKSAT and EUTELSAT. Fiber optic cable network system is functioning as in the capital of Georgia – Tbilisi, so in regions. The magistral fiber optic cable is organized by STM-4 and STM-16 systems of SDH generation. It belongs to the private operator company Foptnet. There are two connection points with Trans-Asia-Europe project – Poti and Tbilisi 7. Internet Service Providers – licensed – 30, actively working 6 with around 100.000 subscribers (<2.5% countrywide, approximately 7% in Tbilisi). Internet connection is realized by dial-up, leased lines and DSL technology. Since 2004 the wireless connection through Motorola’s Canopy technology is available (Point to Point and Point to Multipoint connections in 5,7 GHz Frequency range with TDD / TDMA Half / Full Duplex RJ45 Auto Detect 10 / 100 BaseT Interface).

Number of telephones countrywide – 600.000 (140 per 1.000 population), in Tbilisi – over 450.000 (340 per 1.000). Number of decade-step automatic phone stations countrywide – 33; coordinate automatic phone stations – 48; electron automatic phone stations – 12; digital automatic phone stations – 19. Length of interurban magistral routes – 4.173,5 km; coaxial and symmetrical interurban magistral routes – 7.142 km; air magistral routes – 350,4 km; radio relay lines – 803 km.

Mobile phones – 3 operators (2 GSM standard, 1 – analogue) with over 350.000 mobile phone users 11, 12. MagtiCom – 55.9% subscribers; Geocell – 37.3% subscribers; MegaCom – 6.8% subscribers.

List of Experts

The following individuals agreed to enter Expert Group:
- Dr. La Rosa F.G. - TelePathology Consultants PC (USA)
- Dr. Venkatesh M. Shashidhar - Fiji School of Medicine (Fiji Islands)
- Dr. Neil A. Busis - Neuroguide - Neurosciences in Internet
- Dr. Kurparthy Sambasivaiah
- Prof. Dr. Kurt Possinger - Internal Medicine Clinic Specializing in Oncology and Hematology
- Dr. Helmut Sandeck - Department of Pathology and Medical Genetics, St. Olavs Hospital (Norway)
- Dr. Shaila Shah
- Dr. Angela Spelsberg - Tumorzentrum Aachen (Germany)

After representing of VHCC at Med-e-Tel 2005 the list of Experts will be added by:
- Dr. Maria Zolfo - Prince Leopold Institute of Tropical medicine (Belgium)
- Dr. Jarmo Reponen - Raahe Hospital, President of Finnish Society of Telemedicine (Finland)
- Dr. Nikolay Matveev - Moscow Research Institute for Pediatrics and Children Surgery (Russia)

The expansion of Expert Group and adding of new members will be done in the nearest future.

Expert Group creation

At 10 March 2005 started creation of Expert Group. For this purpose the Invitation Letter was written. It was sent to GTU's partners and also to the individuals and organizations interested about participation in VHCC project. The text of Invitation Letter is given below.



Dear Colleague,

on behalf of our team I would like to introduce you a join project between Georgian Telemedicine Union (GTU) and the Institute of Pathology, University Hospital Berlin Charite - Virtual Health Care Center (VHCC). This is ongoing Networking Infrastructure Project of NATO Scientific Division. The topic of the project is the implementation, evaluation and adaptation of telemedicine services for Georgia. The service will consist of:
• A groupware environment for organizational process;
• An e-Learning environment for the creation of learning;
• A mail server;
• A tool for videoconferences.

Project objectives are:
• A core team for telemedicine support in the Virtual Health Care Center (VHCC);
• At least 3 sig’s (special interest groups) working regularly;
• At least 3 cases discussed by the expert panel;
• At least 10 courses and completed learning material about the service and medical problems.

The installation process of VHCC’s server is already started in Germany (the University of Applied Sciences of Bremerhaven). The technical resources of GTU is upgrading now (the office is located in the capital, Tbilisi). In the closest future tele-medicine unit will be created in Kutaisi (city in West Georgia). The whole information about project implementation, its management, deliverables, realization schema and achieving results can be found at http://vhccgeorgia.blogspot.com.

VHCC is dedicated to the organization of remote consultations and educational course in different medical fields, but of course we must start with fields those are the most actual for Georgia and add the other ones step by step. At present are making emphasize upon pathology, radiology, oncology, cardiology, neurology and medical psychology. Now we are creating the Expert group, which will ensure correct and effective implementation of second opinion consultations and e-Learning sessions. We would like to invite you as an Expert and by this to make contribution in creation of eHealth net in Georgia. This will be honor for us. We’ll be pleased, if you’ll agree to become our partner.


Sincerely yours,

on behalf of VHCC team

Eka Kldiashvili, Ph.D.

Executive Director
Georgian Telemedicine Union

Widespread of VHCC

Successful and correct implementation of telemedicine and e-Health related projects is mainly stipulated by the widespread and popularization of proposals. The joint initiative of GTU and Instite of Pathology, University Hospital Charite was added to the content of ISfTeH newsletter, which was published at the end of March 2005. The project was presented at Med-e-Tel 2005 in Luxembourg at 7 April, 2005.

All interested individuals and organizations are highly wellcome. The main contact persons are:
1. Dr. Thomas Schrader, NATO-country Project Director, thomas.schrader@charite.de
2. Dr. Eka Kldiashvili, Georgia-country Project Co-Director, kldiashvili@georgia.telepathology.org

Analysis of System Environment for Videoconference

For the test of various possibilities to realize videoconference it is essential to analyse your system environment:
1. Type of Interent-Connection: DSL (please specify the upload- and download rate - ask your provider)
2. Type of videoconference system: USB-camera, PC or commercial videoconference equipment

Please send the information about the topic to:
thomas.schrader@charite.de

Proposed Case Management Version 1
Thomas Schrader

The first server of the VHCC project. Mr. Berndt is installing the first server software (LAMP & PHProjekt) supervised by Thomas Schrader.
Thomas Schrader

The installation process of the VHCC Server is started

Mr. Berndt, student of the University of Applied Sciences of Bremerhaven, started with the installation process of the server. He will write his diploma thesis about this very interesting topic of the setup of a complex medical service using open source software.
The webserver Apache is running now. The other software tools will follow.
For the next time we need your input about your wishes and requirements.

Current project plan M.-O. Berndt (diploma thesis)
Thomas Schrader

Base Line Project Plan - Shedule of the Project Proposal (has to be modified)
Thomas Schrader

Proposed Team Structure - many open positions
Thomas Schrader

Project Bugdet

First Year: 8000 Euro
Second Year: 8000 Euro

Capital of Georgia and collaboration within this country.
Thomas Schrader

Georgia & Germany
Thomas Schrader

Project Team

Team Members
Germany

1. Thomas Schrader (Project Co‑Director from NATO country)
2. Mark-Oliver Bernd - Server Administration Germany

Georgia

1. Kldiashvili Eka (Project Co-Director from partner country)
2. Tavzarashvili I.D. - Tblisi
3. Chkhaidze M.I. - Kutaisi
4. Shakulashvili N.G. - Kutaisi

General Time Frame

1. First Server installation - March-May 2005
2. Online-Courses using the service May - September 2005
3. Online-Service Teleconsultation static - December 2005
4. Rapport first year December 2005
5. Second Server installation - Jan-March 2006
7. Online - Teleconsultation dynamic (Videoconferences) May 2006
8. Rapport second year December 2006

Major Stakeholders

1. Georgian Telemedicin Union - GTU, Executive Director: Eka Kldiashvili
2. Institute of Pathology, University Hospital Berlin Charité, Thomas Schrader
3. NATO Infrastructure Program

Project Scope

The topic of this project is the implementation, evaluation and adaptation of telemedicine services for Georgia. The service will consist of

• a groupware environment for organisational process
• a eLearning environement for the creation of learning material, courses about the service and medical problems
• a mail server
• a tool for video conferences

By implementation of the present project to Georgian health care professionals will be given the effective opportunity to connect with each other and with foreign colleagues by usage of worldwide grid of telemedicine based upon the modern computer technologies and Internet connection. This is the real and effective chance to develop health care sector and raise the level and quality of medical service. By realization of the project it will become reality the connection of two Georgian organizations with each other and also with foreign colleagues.
The Project Deliverables are:

1. Conception of the Telemedice Service including the anlysis of requirements
2. Ready-To-Work-Telemedicine server
3. Status-Report about the connectivity of all team members and collaborating hospitals
4. Learning material for the use of the service
5. Status-Report about the video conference modality

Project Objectives are

• a core team for telemedicine support in the VHCC
• at least 3 sig's (special interest groups) working regulary
• at least 3 cases per week discussed by the expert panel of Georgia and Germany
• at least 10 courses and completed learning material about the service and medical problems.

Virtual Health Care Center

This is the project page of the Virtual Health Care Center.